Provider Demographics
NPI:1801631585
Name:HIGDON, AMANDA GAYLE (CRNA, DNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAYLE
Last Name:HIGDON
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GAYLE
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4116 EAGLE WATCH WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-8034
Mailing Address - Country:US
Mailing Address - Phone:812-267-1574
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY4024556367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program